Physical examination–indicated cerclage in twin pregnancy: a randomized controlled trial

We read with great interest the study entitled “Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial” by Roman et al.1Roman A. Zork N. Haeri S. al.Physical trial.Am J Obstet Gynecol. 2020; ([Epub ahead of print])Abstract Full Text PDF Scopus (11) Google Scholar appreciate authors for conducting trial (RCT) on this rare yet enigmatic aspect pregnancy and asymptomatic cervical dilation. However, we wish to make certain observations that will further help comprehending results study. The conclusion was neither conformation AJOG at Glance section nor main title, as aimed assessing efficacy physical examination–indicated but ended up disproportionally concluding addition indomethacin antibiotics along decreases preterm birth. In fact, role and/or prolonging duration independent other factors is well established singleton pregnancies.2Miller E.S. Grobman W.A. Fonseca L. Robinson B.K. Indomethacin cerclage: trial.Obstet 2014; 123: 1311-1316Crossref PubMed (30) Furthermore, “per-protocol” “intention-to-treat” analysis would be important, almost one-fourth patients (4 17 [23.5%]) intervention group did not receive cerclage. Similarly, dose vaginal progesterone its time institution terms gestation have been taken into account may significant effect known decrease births. Moreover, RCTs propensity oversold or undersold, has emphasized Deaton Cartwright. Randomization aims achieve, does ensure, equalization all confounders, post hoc needed reveal covariates.3Deaton Cartwright Understanding misunderstanding trials.Soc Sci Med. 2018; 210: 2-21Crossref (364) There clinically difference histologic chorioamnionitis 2 groups (23.5% vs 61.5%) even though it failed reach statistical significance seemingly small margin (P=.06). This distribution baseline characteristics chorioamnionitis, gestational age premature rupture membranes, antenatal corticosteroids, an perinatal mortality. These confounders need due consideration, thus, assimilated caution. surgical intervention, fraught inherent risks (10%–20%) laceration cervix, bleeding, inducing contractions, etc., more so pregnancy.4Berghella V. Ludmir J. Simonazzi G. Owen Transvaginal evidence perioperative management strategies.Am 2013; 209: 181-192Abstract (55) Lastly, important share information how many subjects procedural complications (even if minor) were encountered Physical trialAmerican Journal Obstetrics & GynecologyVol. 223Issue 6PreviewWomen pregnancies dilated cervix second trimester are increased risk loss early birth; there currently no proven therapy prevent birth women. Full-Text ReplyAmerican 224Issue 1PreviewWe comments Dr Kaur colleagues1 regarding our recent publication trial.” I agree should included combination cerclage, indomethacin, associated significantly different outcome compared control. Those therapies original protocol. most obstetricians adopted findings Miller al.